64-SCTCA诊断冠心病疑似患者的准确性分析

Diagnostic accuracy of 64-SCTCA in patients with suspected coronary artery disease

目的探讨64层螺旋CT冠状动脉成像(64-SCTCA)对冠心病疑似患者诊断的准确性及其影响因素。方法分析80例接受64-SCTCA检查的冠心病疑似患者的临床资料。将患者依据冠心病概率Duke模型分为低危组(n=25)、中危组(n=25)和高危组(n=30)。以CAG为"金标准",判断64-SCTCA诊断各组患者的准确性及冠状动脉钙化、不同部位血管节段等因素对诊断准确性的影响。结果 64-SCTCA诊断冠心病的敏感性、特异性、阳性预测值和阴性预测值分别为82.4%、93.3%、68.4%、96.8%;低危组的敏感性、阳性预测值和诊断准确指数均明显低于中、高危组(P<0.05);冠状动脉钙化积分>400组的敏感性明显高于0～100分组和101～400分组(P<0.05),而特异性明显低于其他两组(P<0.05);诊断远端血管病变的敏感性、阳性预测值均明显低于近、中段血管(P<0.05)。结论 64-SCTCA主要适用于冠心病Duke模型中的中危人群,其诊断准确性受冠状动脉钙化、病变部位、管腔直径等因素影响。

Objective To explore the diagnostic accuracy and influence factors of 64-slice computed tomogra- phy coronary angiography （64-SCTCA） in patients with suspected coronary artery disease （CAD）. Methods Eighty patients with suspected coronary artery disease who examined by 64-SCTCA was analyzed. The patients were divided into three groups according to Duke probability model： low risk group （n=25）, intermediate risk group （n=25）, high risk group （n=30）. The diagnostic accuracy of 64-SCTCA was judged and the influence factors of diagnostic accuracy including coronary artery calcification, different parts of the blood vessel segment were evaluated. Results The pa- tient-based diagnostic accuracy of 64-SCTCA for detecting CAD according to CAG revealed a sensitivity of 82.4%, a specificity of 93.3%, a positive predictive value of 68.4% and a negative predictive value of 96.8%. The sensitivity, positive predictive value and negative predictive value in low risk group were all lower than those in intermediate risk group and high risk group （P〈0.05）. For those with coronary artery calcium score〉400, the diagnostic accuracy was linked with a higher sensitivity （P〈0.05） but a lower specificity （P〈0.05）. The diagnostic value of 64-SCTCA for proximal and mid-segment of coronary artery was superior to that for distal segment （P〈0.05）. Conclusion 64-SCT- CA is mainly indicated in individuals with an intermediate probability of having CAD. The diagnostic value of 64-SCTCA could be affected by coronary artery calcium, lesion location and vessel diameter.